Bill S6054A-2011

Relates to the purchase of prescription drugs

Relates to the purchase of prescription drugs; relates to applicable terms and conditions of participating mail order or other non-retail pharmacy.

Details

Actions

  • Feb 6, 2012: SUBSTITUTED BY A8904
  • Jan 9, 2012: ORDERED TO THIRD READING CAL.11
  • Jan 9, 2012: REPORTED AND COMMITTED TO RULES
  • Jan 4, 2012: PRINT NUMBER 6054A
  • Jan 4, 2012: AMEND AND RECOMMIT TO INSURANCE
  • Jan 4, 2012: REFERRED TO INSURANCE
  • Jan 4, 2012: REFERRED TO INSURANCE

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Memo

BILL NUMBER:S6054A

TITLE OF BILL: An act to amend the insurance law, in relation to the purchase of prescription drugs

PURPOSE OR GENERAL IDEA OF BILL: The purpose of this bill is to make clarifying changes to Chapter 597 of the Laws of 2011 to ensure proper implementation of the intent of the law.

SUMMARY OF SPECIFIC PROVISIONS: This bill would amend sections 3216, 3221 and 4303 of the Insurance Law to simplify the statute by establishing that if an individual chooses to purchase their prescription drugs at a network participating non-mail order retail pharmacy, such pharmacy would be required to accept the same contractual terms and conditions that the insurer has established with the network participating mail order and non-retail specialty pharmacies.

The bill would also make conforming changes within sections 3216, 3221 and 4303 of the Insurance Law that are necessary for the implementation of these provisions as well as other minor technical modifications to ensure consistency with existing law.

JUSTIFICATION: The Legislature's intent in enacting Chapter 597 of the Laws of 2011 was to ensure that consumers would be afforded a choice in how they make their prescription drug purchases. These amendments are intended to simplify the previsions of Chapter 597 to make implementation easier for insurance companies and affected pharmacies.

PRIOR LEGISLATIVE HISTORY: This is a new bill.

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS: Unknown.

EFFECTIVE DATE: This act shall take effect on the same date and in the same manner as Chapter 597 of the Laws of 2011.


Text

STATE OF NEW YORK ________________________________________________________________________ 6054--A IN SENATE (PREFILED) January 4, 2012 ___________
Introduced by Sen. MAZIARZ -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, in relation to the purchase of prescription drugs THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Paragraph 28 of subsection (i) of section 3216 of the insurance law, as added by chapter 597 of the laws of 2011, is amended to read as follows: (28) Any policy [which] THAT provides coverage for prescription drugs shall permit each [participant] INSURED to fill any [mail order] covered prescription THAT MAY BE OBTAINED AT A NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY, at [his or her] THE INSURED'S option, at [any mail order pharmacy or] A network participating non-mail order retail pharmacy [if the network participating non-mail order retail pharmacy offers to accept a price that is comparable to that of the mail order pharmacy] PROVIDED THAT THE NETWORK PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY AGREES IN ADVANCE, THROUGH A CONTRACTUAL NETWORK AGREE- MENT, TO THE SAME REIMBURSEMENT AMOUNT, AS WELL AS THE SAME APPLICABLE TERMS AND CONDITIONS, THAT THE INSURER HAS ESTABLISHED FOR THE NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY. [Any policy which provides coverage for prescription drugs] IN SUCH A CASE, THE POLICY shall not impose a co-payment fee or other condition on any insured who elects to purchase PRESCRIPTION drugs from a network partic- ipating non-mail order retail pharmacy which is not also imposed on insureds electing to purchase drugs from a [designated] NETWORK PARTIC- IPATING mail order OR OTHER NON-RETAIL pharmacy[; provided, however, that the provisions of this section shall not supersede the terms of a collective bargaining agreement or apply to a policy that is the result of a collective bargaining agreement between an employer and a recog- nized or certified employee organization].
S 2. Paragraph 18 of subsection (1) of section 3221 of the insurance law, as added by chapter 597 of the laws of 2011, is amended to read as follows: (18) Any insurer delivering a group or blanket policy or issuing a group or blanket policy for delivery in this state [which] THAT provides coverage for prescription drugs shall permit each [participant] INSURED to fill any [mail order] covered prescription THAT MAY BE OBTAINED AT A NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY, at [his or her] THE INSURED'S option, at [any mail order pharmacy or] A network participating non-mail order retail pharmacy [if the network participat- ing non-mail order retail pharmacy offers to accept a price that is comparable to that of the mail order pharmacy] PROVIDED THAT THE NETWORK PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY AGREES IN ADVANCE, THROUGH A CONTRACTUAL NETWORK AGREEMENT, TO THE SAME REIMBURSEMENT AMOUNT, AS WELL AS THE SAME APPLICABLE TERMS AND CONDITIONS, THAT THE INSURER HAS ESTABLISHED FOR THE NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY. [Any policy which provides coverage for prescription drugs] IN SUCH A CASE, THE POLICY shall not impose a co-payment fee or other condition on any insured who elects to purchase drugs from a network participating non-mail order retail pharmacy which is not also imposed on insureds electing to purchase drugs from a [designated] NETWORK PARTICIPATING mail order OR OTHER NON-RETAIL pharmacy; provided, howev- er, that the provisions of this section shall not supersede the terms of a collective bargaining agreement or apply to a policy that is the result of a collective bargaining agreement between an employer and a recognized or certified employee organization. S 3. Subsection (hh) of section 4303 of the insurance law, as added by chapter 597 of the laws of 2011, is amended to read as follows: (hh) Any [policy] CONTRACT issued by a medical expense indemnity corporation, a hospital service corporation or a health services corpo- ration [which] THAT provides coverage for prescription drugs shall permit each [participant] COVERED PERSON to fill any [mail order] covered prescription THAT MAY BE OBTAINED AT A NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY, at [his or her] THE COVERED PERSON'S option, at [any mail order pharmacy or] A network participating non-mail order retail pharmacy [if the network participating non-mail order retail pharmacy offers to accept a price that is comparable to that of the mail order pharmacy] PROVIDED THAT THE NETWORK PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY AGREES IN ADVANCE, THROUGH A CONTRACTUAL NETWORK AGREEMENT, TO THE SAME REIMBURSEMENT AMOUNT, AS WELL AS THE SAME APPLICABLE TERMS AND CONDITIONS, THAT THE CORPORATION HAS ESTABLISHED FOR THE NETWORK PARTICIPATING MAIL ORDER OR OTHER NON-RETAIL PHARMACY. [Any policy which provides coverage for prescription drugs] IN SUCH A CASE, THE CONTRACT shall not impose a copayment fee or other condition on any [insured] COVERED PERSON who elects to purchase drugs from a network participating non-mail order retail pharmacy which is not also imposed on [insureds] COVERED PERSONS electing to purchase drugs from a [designated] NETWORK PARTICIPATING mail order OR OTHER NON-RETAIL phar- macy; provided, however, that the provisions of this section shall not supersede the terms of a collective bargaining agreement or apply to a [policy] CONTRACT that is the result of a collective bargaining agree- ment between an employer and a recognized or certified employee organ- ization. S 4. This act shall take effect on the same date and in the same manner as chapter 597 of the laws of 2011, takes effect.

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